Support From a Distance: How Home Care Agencies Influence Paid Caregiving in the Home

Abstract Paid caregivers (e.g., home health aides, personal care attendants, and other direct care workers) who care for functionally impaired older adults in the home frequently report that while rewarding, their work is logistically, physically, and emotionally demanding. Unlike direct care workers in institutional settings, paid caregivers work with care recipients one-on-one in private settings and often have limited contact with or support from their employers. These factors contribute to high workforce turnover and may impact the quality of patient care. In this symposium, we explore ways that home care agency policies and practices influence the experience of giving and receiving care in the home. First, Bryant et al. describe the range of agency-based models and the impact of workplace design in creating supportive working environments. Next, Fabius et al. explore characteristics of direct care agencies across Maryland, with implications for worker training and support. Reckrey et al. describe the differing perceptions of aides, caregivers and providers around the role agencies play in defining paid caregivers’ roles, and how this may lead to conflict within the caregiving team. Finally, in the context of COVID-19, Franzosa et al. examine communication and coordination between Veterans Affairs-paid agencies and home health aides during the pandemic, while Tsui et al. present a case study of an agency’s efforts to support paid caregivers through group support calls. Together, these studies highlight challenges in the structure, organization and perceptions of home care agencies, and identify potential avenues for agencies to support paid caregivers and their clients.

and psychological adaptation. Research examining the relationship of pet ownership (PO) or human-animal interaction (HAI) to human health supports contributions to these successful ag-ing-related outcomes at some point in the lifecycle, mostly in populations with diseases or disabili-ties. We examine the contributions of PO to maintaining physical capacity among generally healthy community-dwelling older participants in the Baltimore Longitudinal Study of Aging (BLSA). Partici-pants' [N=637, mean age=68.3 years (SD=9.6), pet owners N=149] completed a standardized physi-cal function test battery (among other measures) every 1-4 years and a ten-year PO history. Linear mixed, or generalized linear mixed, models with time varying PO were used to examine change in successful aging-related outcomes over up to 13 years [mean=7.5, (SD=3.6)] according to PO. Physi-cal function declined across all domains examined, but was observed to be less severe with PO in overall physical performance (p<0.001), rapid gait speed (p=0.041), 400meter walk time (p<0.001), and reported physical wellbeing (p=0.032). No differences were observed for grip strength (p=0.56), usual gait speed (p=0.07), and leisure time physical activity (p=0.26) after con-trolling for age. This study provides the first longitudinal evidence that PO may promote successful aging among community-dwelling healthy older adults by moderating age-related declines in physical functional status in late-life. Culture, embedded in language and reflected in colloquial expressions, influences behaviors and cognitive constructs that affect health. To reach Latino older adults, health promotion efforts should include congruent cultural aspectssuch as relevant metaphors, values, and proverbs-that will resonate with their cognitive constructs. However, this content should also be situated within a broader social context. For community-dwelling Latino older adults, this means considering their care systems and the multiple stakeholders within. In this paper presentation, we describe an innovative, interdisciplinary collaboration to culturally and linguistically adapt existing Illinois Extension curricula to meet the needs of Latino older adults and their families living in Cook County, which includes Chicago and its neighboring suburbs. We will demonstrate how concept-mapping (CM) studies can be used to structure the cultural adaptation of educational curriculum to a Latino audience. Specifically, we describe these CM studies, which asked how multiple stakeholders and Latino older adults living in the Chicagoland area defined positive aging provided empirically-grounded direction for our 11-member steering committee, composed of investigators, service leaders, and Latino older adults. We also will describe how the current project deepens relationships in the community that facilitate dissemination efforts to Latino older adults. Pets can play an important role in older adults' health behaviors and decisions. However, the degree to which these issues are encountered or addressed by professionals working with this population remains unknown. An interdisciplinary (e.g., healthcare, social services) sample of professionals (N=72, 93.05% female, Mage=48.82, SDage=12.57) completed an online survey focused on the pet ownership issues they have encountered while working with older adults, persons with dementia, and care partners. The professionals (n=66) estimated 42.86% of their clients had been pet owners, and 45.58% regularly asked their clients about pets. Issues raised to the professionals varied by type of client. Older adults most often brought up exercising the pet, routine veterinary care, and the financial aspect of ownership (all 37.50%). Persons with dementia most often discussed accessing pet care items (12.50%), exercising the pet (9.72%), and basic pet care (8.33%). Care partners brought up basic pet care (33.33%), planning for the pet due to their care recipients' housing transition (26.38%), and exercising the pet (25.00%). Professionals reported talking to clients about planning for the pet due to housing transition, concerns about falling, and concerns about the pet's behavior (all 31.94%). The professionals (n=69) were very favorable toward pet ownership in general (M=4.43, SD=0.78) (1=extremely unfavorable, 5=extremely favorable), less favorable about older adult pet ownership (M=4.15, SD=0.72, p=.002), and even less favorable about persons with dementia owning pets (M=3.51, SD=0.93, p<.001). The results provide evidence that pet ownership issues are likely encountered in geriatric service settings and may shape healthy aging.

SUPPORT FROM A DISTANCE: HOW HOME CARE AGENCIES INFLUENCE PAID CAREGIVING IN THE HOME Chair: Emily Franzosa Discussant: Robyn Stone
Paid caregivers (e.g., home health aides, personal care attendants, and other direct care workers) who care for functionally impaired older adults in the home frequently report that while rewarding, their work is logistically, physically, and emotionally demanding. Unlike direct care workers in institutional settings, paid caregivers work with care recipients one-on-one in private settings and often have limited contact with or support from their employers. These factors contribute to high workforce turnover and may impact the quality of patient care. In this symposium, we explore ways that home care agency policies and practices influence the experience of giving and receiving care in the home. First, Bryant et al. describe the range of agency-based models and the impact of workplace design in creating supportive working environments. Next, Fabius et al. explore characteristics of direct care agencies across Maryland, with implications for worker training and support. Reckrey et al. describe the differing perceptions of aides, caregivers and providers around the role agencies play in defining paid caregivers' roles, and how this may lead to conflict within the caregiving team. Finally, in the context of COVID-19, Franzosa et al. examine communication and coordination between Veterans Affairs-paid agencies and home health aides during the pandemic, while Tsui et al. present a case study of an agency's efforts to support paid caregivers through group support calls. Together, these studies highlight challenges in the structure, organization and perceptions of home care agencies, and identify potential avenues for agencies to support paid caregivers and their clients.

JOB DESIGN FOR HOME CARE WORK: PERSPECTIVES FROM EMPLOYERS AND HOME CARE AIDES
Robyn Stone, 1 Alex Hennessa, 2 and Natasha Bryant, 2

LeadingAge, Washington, District of Columbia, United States, 2. LeadingAge LTSS Center @UMass Boston, Washington, District of Columbia, United States
Home-based care is a rapidly growing sector becoming more important to individuals, families, providers, and payers. The ways in which agencies create the work environment for home care aides who are essentially in their clients' homes is not adequately documented and may be changing rapidly with labor market innovations. This qualitative study describes how different home care business models (e.g., non-profit VNAs, for-profit franchises, uber-style matching, worker-owned coops) address job design and the overall work environment for home care aides. Interviews with employers and focus groups with home care aides examine workplace practices, how work is organized and supported when the workforce is virtual and the workplace is a client's home, and the perceived attributes of a positive workplace environment across business models. This study fills significant knowledge gaps about home care workplace design and the role of agencies in creating a supportive environment.

CHARACTERISTICS, CHALLENGES, AND SUPPORT OF MARYLAND'S DIRECT CARE WORKERS: FINDINGS FROM A STATEWIDE AGENCY SURVEY
Deirdre Johnston, 1 Jennifer Wolff, 2 and Chanee Fabius, 2 , 1. Johns Hopkins University, Baltimore, Maryland, United States, 2. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States Direct care workers (e.g., personal care aides) are paid health care professionals who provide hands on assistance with daily activities to persons with disabilities in home, community, and institutional settings. Many workers are employed by direct care agencies, but little is known or understood about the organizational attributes of these agencies. We describe results from a mixed mode (postal mail, electronic, and telephone) survey of n=1112 residential care agency administrators in Maryland to assess organizational (e.g., size, supplemental services) and direct care worker (e.g., training) characteristics. Preliminary findings indicate that half of direct care agencies' revenue comes from Medicaid and roughly 40% of clients are living with dementia. Administrators report challenges managing dementia-related behaviors (70%), communicating with persons living with dementia (63%) and interacting with family caregivers (63%). Findings from this work will inform the development of an organizational level intervention that targets training and support of direct care workers.

WHOSE DECISION IS IT? PERSPECTIVES ON AGENCY INVOLVEMENT IN DETERMINING PAID CAREGIVERS' ROLES IN DEMENTIA CARE
Deborah Watman, 1 Emma Tsui, 2 and Jennifer Reckrey, 3 1. Icahn School of Medicine at Mount Sinai,New York,New York,United States,2. CUNY Graduate School of Public Health & Health Policy,CUNY Graduate School of Public Health & Health Policy,New York,United States,3. Icahn School of Medicine at Mount Sinai,Icahn School of Medicine at Mount Sinai,New York,United States Individuals living at home with dementia often rely on a team of caregivers and health care providers. Yet little is known about how the role of paid caregivers within this team is determined. We identified patients with moderate to severe dementia (n=9) and conducted individual interviews with their care teams (family caregiver, paid caregiver, physician) (n=27) to explore perspectives on paid caregiver roles. Participants disagreed on who determined the paid caregiver's role. Agencies were perceived to set limitations on the scope of care (particularly by physicians) but agency care plans were often seen as inadequate and failing to capture important nuances of care. Most family caregivers believed they should guide what paid caregivers did in the home, while most paid caregivers reported relying on their own experience and knowledge. Understanding and addressing these differing perceptions is critical to improving the quality of paid care in the home.

. Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
Home health aides are essential members of the home care team, but often report limited communication with agency supervisors. To explore the impact of COVID-19 on these dynamics, we conducted semi-structured interviews with providers (n=9), contracted home health agencies (n=6), and aides caring for veterans (n=8) at an urban Veterans Affairs medical center. Data were analyzed through thematic analysis. Agencies relied on aides to observe and report on patients' conditions, including COVID-19 symptoms, but aides were not always aware of follow-up and wanted more information about their patients' health and COVID-19 status. Agencies also reported providing personal protective equipment (PPE) and infection prevention guidance to aides; however, some aides reported purchasing their own PPE and seeking out private COVID-19 testing. Supporting aides